normal and pathological gaitpesquisa.ufabc.edu.br/.../uploads/2017/07/engrehab_human-gait_fin… ·...
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Normal and Pathological Gait
Introduction • Human gait – locomotion
• Bipedal, biphasic forward propulsion of centre
of gravity of the human body, in which there
are alternate sinuous movements of different
segments of the body with least expenditure
of energy.
• Normal gait: stability in stance; clearance in
swing; adequate step length; energy
conservation; support of bodyweight
Gage 1991; Baker 2009
http://demotu.org/blog/gait-andar-e-marcha-a-re/#more-948
Natural gait: • speed increases = walk, jog, skip, run and sprint
• Designed to propel a person forward, but can also be adapted for
lateral movment.
Walk Skip Run
-‐ At least one foot is in contact with the floor at all 2mes.
-‐ Gait children 4-‐5 yrs. old (Mine< 2015). -‐ Computa2onal simula2ons showed that skipping is more efficient and less fa2guing than walking or running (Ackermann and Bogert 2015)
-‐ Both feet lose contact with the ground.
Spatial parameters
Baker 2013; Whittle 2007
Temporal parameters
Speed (m/s) = stride length (m) x cadence (steps/min) 120
Stride time = duration of one gait cycle
Cadence(steps/minute) = number of steps in a given time.
Baker 2013
Gait cycle
Gait parameters
Whittle 2007
Rockers
https://www.youtube.com/watch?v=QuaEdhgLdKM
Gait in the children 1. The walking base is wider 2. The stride length and speed
are lower and the cycle time shorter (higher cadence) 3. Small children have no heel strike, initial contact being made by the flat foot 4. There is a little knee flexion
during the stance phase 5. The whole leg is externally
rotated during the swing phase 6. There is an absence of reciprocal arm swinging
Whittle 2007
Gait in the elderly Two influences: 1. The effects of age itself 2. The effects of pathological
conditions, such as OA and parkinsonism • Decreased stride length • Increase the walking base • Increase the duration of stance
phase • Speed is reduced
Whittle 2007
Abnormal gait: Complex interaction between the many neuromuscular and structural elements of the locomotor system. When studying a pathological gait, it is helpful to remember that an abnormal movement may be performed for one of two reasons: 1. The subject has no choice, the
movement being ‘forced’ on them by weakness, spasticity or deformity
2. The movement is a compensation, which the subject is using to correct for some other problem, which therefore needs to be identified.
Whittle 2007 https://www.youtube.com/watch?v=lIOP2RT_9uQ
Abnormal gait: • Neuromuscular
• Musculoskeletal
• Painful due to arthritis
• Weakness
• Drop Foot
Lateral trunk bending Trendelenburg gait. https://www.youtube.com/watch?v=ZUPQp5oxXj8
Trunk bending
Functional leg length discrepancy Circumduction
Hip hiking
Steppage Vaulting
Excessive knee extension
https://www.youtube.com/watch?v=V02GoT-N58c
Excessive knee flexion https://www.youtube.com/watch?v=b_j327371fM
Foot
1. Abnormal foot contact https://www.youtube.com/watch?v=pmRwDMDDv98 https://www.youtube.com/watch?v=vfw58BXdCPc 2. Abnormal foot rotation 3. Insufficient push off
Pathological Gait
https://www.youtube.com/watch?v=S3R6DsJOblk
Walking aids
Assistive devices: canes, crutches and frames. 1. To improve stability; 2. To generate a moment; 3. Reduce limb loading
Walking with aids
1. Four-point gait; 2. Three-point gait; 3. Two-point gait;
Amputee gait
1. Above the knee (AK) 2. Below the knee (BK) 3. At the level of the ankle (Syme’s )
Spastic cerebral palsy
https://www.youtube.com/watch?v=n6v7HCmVIrU https://www.youtube.com/watch?v=1S27RaQ-A7Q
Crouch gait • Consider degrees of severity
• Knee flexion > 30 deg, ankle dorsiflexion > 2SD,
Reduced hip extension
• Increased oxygen consumption and effort
• Increased joint loads: pain and stress fractures
https://www.youtube.com/watch?v=HLFQM1e-vJw
- Unilateral weakness - Leg extended with plantarflexion - Cirdunduction due to the
weakness of the distal muscles, equinus foot and extension hiperthony of the lower limb.
Hemiplegic gait
- Spasticity of both limbs. Affecting more lower than upper limb.
- Support base narrow. - Stiffness of adductor muscles,
“scisor” gait.
Diplegic gait
- Equinus foot (weakness of dorsiflexors).
- Unilateral – paralysis of the fibularis nerve – radiculopathy of L5.
- Bilateral – Amyotrophic Lateral Sclesoris, Charcot-Marie-Tooth
Neuropathy gait
- Trendelenburg – weakness of the abductors of the hip. - Muscular dystrophy.
Miopathic gait
- Abnormal, uncoordinate movements. - Unsteady, staggering gait because
walking is uncoordinated and appears to be ‘not ordered’.
Ataxic gait
- 3 classical signais: resting tremor, rigidity, and bradykinesia.
- Head and neck forward, and knee flexed.
- Slow gait with short steps. - Difficulty in starting the movement.
Parkinsonian gait
Diplegic gait
Miopathic gait
Parkinsonian gait
Ataxic gait
Neuropathic gait